Madhu Rajaraman

Despite similarities in behavior, some children diagnosed with autism spectrum disorders under the DSM-IV-TR could lose their diagnosis as a result of the new manual’s stricter diagnostic criteria.

A recent study shows that 46.7% of toddlers diagnosed with autism spectrum disorders (ASDs) under the DSM-IV-TR (the previous version of the diagnosis manual) will no longer meet autism spectrum criteria under the DSM-5. The new version of the go-to psychiatric manual imposes a rigorous set of criteria for diagnosis, requiring more total symptoms to be met in the areas of social/communication deficits and repetitive/restrictive behaviors than did the DSM-IV-TR.

"The definition of autism has evolved over the years, with previous modifications of the DSM criteria resulting in marked effects on prevalence rates," wrote study author Lindsey W. Williams of Louisiana State University, Baton Rouge. This change is important to note, she said, because DSM-based diagnoses are "widely used by insurance and service providers to qualify individuals for services."

Autism spectrum disorders are characterized by three general defining factors: social skills deficits, communication impairments, and repetitive/restricted behaviors. Services used to treat autism may include early intensive behavioral intervention (EIBI), speech therapy, physical therapy, and occupational therapy.

This study evaluated challenging behaviors in 3,339 toddlers aged 17 months to 37 months. Children were divided into three groups: DSM-5, DSM-IV-TR only, and atypically developing/non-ASD. The DSM-5 toddlers met DSM-IV-TR criteria for autism, and maintained this diagnosis under the new DSM-5 requirements. The second group did not meet the new criteria but did meet ASD criteria under the DSM-IV-TR. The last group consisted of children who did not meet ASD criteria under either version of the DSM but did have some symptoms of atypical or delayed development.

Investigators made diagnoses using a series of evaluation tools for autism, including the DSM-5; DSM-IV-TR; Modified Checklist for Autism in Toddlers (M-CHAT); Battelle developmental inventory, second edition (BDI-2); and the Baby and Infant Screen for Children with aUtism Traits (BISCUIT). "Challenging behavior types" were categorized as aggressive/destructive behaviors, stereotyped behaviors, and self-injurious behaviors.

The study found that the three groups did not significantly differ based on sex or race. The results, in accordance with prior research, show that 46.7% of children diagnosed on the autism spectrum under DSM-IV-TR criteria will no longer meet the requirements for ASD under the DSM-5.

Significant differences were found among all groups with regard to challenging behaviors, with a large effect size found between the atypically developing (non-ASD) and severe ASD DSM-5 groups. In a comparison of the DSM-IV-TR and DSM-5 groups, medium effect sizes were found for aggressive destructive behaviors and self-injurious behaviors, and large effect sizes were found for stereotyped and total problem behaviors. A comparison of the DSM-IV-TR group with the atypically developing group found medium effect sizes across all behavior types.

Children with the most severe symptoms and challenging behaviors probably will be able to retain their ASD diagnosis under the DSM-5, but the investigators expressed concern about the decreased sensitivity of the new requirements, stating that "individuals who no longer qualify for an ASD diagnosis ... will nonetheless continue to have significant behavioral issues warranting behavioral intervention," especially because the DSM-IV-TR group more closely resembled the DSM-5 group in this study.

It is unclear how the new diagnostic criteria will affect access to therapies for children who no longer meet ASD criteria, but they said that "it is imperative that a loss of ASD diagnosis does not disqualify individuals from receiving important behavioral interventions," wrote Ms. Williams, a doctoral student in the clinical psychology program at the university.

The investigators had no financial disclosures to report.

mrajaraman@frontlinemedcom.com

Despite similarities in behavior, some children diagnosed with autism spectrum disorders under the DSM-IV-TR could lose their diagnosis as a result of the new manual’s stricter diagnostic criteria.

A recent study shows that 46.7% of toddlers diagnosed with autism spectrum disorders (ASDs) under the DSM-IV-TR (the previous version of the diagnosis manual) will no longer meet autism spectrum criteria under the DSM-5. The new version of the go-to psychiatric manual imposes a rigorous set of criteria for diagnosis, requiring more total symptoms to be met in the areas of social/communication deficits and repetitive/restrictive behaviors than did the DSM-IV-TR.

"The definition of autism has evolved over the years, with previous modifications of the DSM criteria resulting in marked effects on prevalence rates," wrote study author Lindsey W. Williams of Louisiana State University, Baton Rouge. This change is important to note, she said, because DSM-based diagnoses are "widely used by insurance and service providers to qualify individuals for services."

Autism spectrum disorders are characterized by three general defining factors: social skills deficits, communication impairments, and repetitive/restricted behaviors. Services used to treat autism may include early intensive behavioral intervention (EIBI), speech therapy, physical therapy, and occupational therapy.

This study evaluated challenging behaviors in 3,339 toddlers aged 17 months to 37 months. Children were divided into three groups: DSM-5, DSM-IV-TR only, and atypically developing/non-ASD. The DSM-5 toddlers met DSM-IV-TR criteria for autism, and maintained this diagnosis under the new DSM-5 requirements. The second group did not meet the new criteria but did meet ASD criteria under the DSM-IV-TR. The last group consisted of children who did not meet ASD criteria under either version of the DSM but did have some symptoms of atypical or delayed development.

Investigators made diagnoses using a series of evaluation tools for autism, including the DSM-5; DSM-IV-TR; Modified Checklist for Autism in Toddlers (M-CHAT); Battelle developmental inventory, second edition (BDI-2); and the Baby and Infant Screen for Children with aUtism Traits (BISCUIT). "Challenging behavior types" were categorized as aggressive/destructive behaviors, stereotyped behaviors, and self-injurious behaviors.

The study found that the three groups did not significantly differ based on sex or race. The results, in accordance with prior research, show that 46.7% of children diagnosed on the autism spectrum under DSM-IV-TR criteria will no longer meet the requirements for ASD under the DSM-5.

Significant differences were found among all groups with regard to challenging behaviors, with a large effect size found between the atypically developing (non-ASD) and severe ASD DSM-5 groups. In a comparison of the DSM-IV-TR and DSM-5 groups, medium effect sizes were found for aggressive destructive behaviors and self-injurious behaviors, and large effect sizes were found for stereotyped and total problem behaviors. A comparison of the DSM-IV-TR group with the atypically developing group found medium effect sizes across all behavior types.

Children with the most severe symptoms and challenging behaviors probably will be able to retain their ASD diagnosis under the DSM-5, but the investigators expressed concern about the decreased sensitivity of the new requirements, stating that "individuals who no longer qualify for an ASD diagnosis ... will nonetheless continue to have significant behavioral issues warranting behavioral intervention," especially because the DSM-IV-TR group more closely resembled the DSM-5 group in this study.

It is unclear how the new diagnostic criteria will affect access to therapies for children who no longer meet ASD criteria, but they said that "it is imperative that a loss of ASD diagnosis does not disqualify individuals from receiving important behavioral interventions," wrote Ms. Williams, a doctoral student in the clinical psychology program at the university.

The investigators had no financial disclosures to report.

mrajaraman@frontlinemedcom.com

Despite similarities in behavior, some children diagnosed with autism spectrum disorders under the DSM-IV-TR could lose their diagnosis as a result of the new manual’s stricter diagnostic criteria.

A recent study shows that 46.7% of toddlers diagnosed with autism spectrum disorders (ASDs) under the DSM-IV-TR (the previous version of the diagnosis manual) will no longer meet autism spectrum criteria under the DSM-5. The new version of the go-to psychiatric manual imposes a rigorous set of criteria for diagnosis, requiring more total symptoms to be met in the areas of social/communication deficits and repetitive/restrictive behaviors than did the DSM-IV-TR.

"The definition of autism has evolved over the years, with previous modifications of the DSM criteria resulting in marked effects on prevalence rates," wrote study author Lindsey W. Williams of Louisiana State University, Baton Rouge. This change is important to note, she said, because DSM-based diagnoses are "widely used by insurance and service providers to qualify individuals for services."

Autism spectrum disorders are characterized by three general defining factors: social skills deficits, communication impairments, and repetitive/restricted behaviors. Services used to treat autism may include early intensive behavioral intervention (EIBI), speech therapy, physical therapy, and occupational therapy.

This study evaluated challenging behaviors in 3,339 toddlers aged 17 months to 37 months. Children were divided into three groups: DSM-5, DSM-IV-TR only, and atypically developing/non-ASD. The DSM-5 toddlers met DSM-IV-TR criteria for autism, and maintained this diagnosis under the new DSM-5 requirements. The second group did not meet the new criteria but did meet ASD criteria under the DSM-IV-TR. The last group consisted of children who did not meet ASD criteria under either version of the DSM but did have some symptoms of atypical or delayed development.

Investigators made diagnoses using a series of evaluation tools for autism, including the DSM-5; DSM-IV-TR; Modified Checklist for Autism in Toddlers (M-CHAT); Battelle developmental inventory, second edition (BDI-2); and the Baby and Infant Screen for Children with aUtism Traits (BISCUIT). "Challenging behavior types" were categorized as aggressive/destructive behaviors, stereotyped behaviors, and self-injurious behaviors.

The study found that the three groups did not significantly differ based on sex or race. The results, in accordance with prior research, show that 46.7% of children diagnosed on the autism spectrum under DSM-IV-TR criteria will no longer meet the requirements for ASD under the DSM-5.

Significant differences were found among all groups with regard to challenging behaviors, with a large effect size found between the atypically developing (non-ASD) and severe ASD DSM-5 groups. In a comparison of the DSM-IV-TR and DSM-5 groups, medium effect sizes were found for aggressive destructive behaviors and self-injurious behaviors, and large effect sizes were found for stereotyped and total problem behaviors. A comparison of the DSM-IV-TR group with the atypically developing group found medium effect sizes across all behavior types.

Children with the most severe symptoms and challenging behaviors probably will be able to retain their ASD diagnosis under the DSM-5, but the investigators expressed concern about the decreased sensitivity of the new requirements, stating that "individuals who no longer qualify for an ASD diagnosis ... will nonetheless continue to have significant behavioral issues warranting behavioral intervention," especially because the DSM-IV-TR group more closely resembled the DSM-5 group in this study.

It is unclear how the new diagnostic criteria will affect access to therapies for children who no longer meet ASD criteria, but they said that "it is imperative that a loss of ASD diagnosis does not disqualify individuals from receiving important behavioral interventions," wrote Ms. Williams, a doctoral student in the clinical psychology program at the university.

The investigators had no financial disclosures to report.

mrajaraman@frontlinemedcom.com

A new Centers for Disease Control and Prevention report has found a decline in homicide rates among U.S. residents aged 10-24 years, reaching a 30-year low of 7.5/100,000 in 2010.

Using data from the National Vital Statistics System, CDC analyzed youth homicide data from 1981 to 2010. Rates varied considerably over the 30-year period, with a sharp rise of 83% occurring from 1985 to 1993, but homicide rates in the youth population experienced a decline starting in 1994; that decline has slowed since 1999. Firearm homicides consistently outnumbered non–firearm homicides as the cause of death; the annual rate of firearm homicides was 3.7 times that of non–firearm homicides during the 30-year period (MMWR 2013,62:545-8).

"These findings highlight the fact that despite an overall decline in homicide to a 30-year low in 2010, some adolescents and young adults remain disproportionately affected," the study authors wrote. In 2010, homicide rates per 100,000 were 12.7 in males, 13.2 in the 20- to 24-year-old age group, and 28.8 for blacks.

The authors added that although there has been a decline in homicides among these high-risk populations, progress has slowed. A violence prevention approach starting in childhood is key to facilitating a continued reduction of youth homicide rates, they said. Such programs may include nonviolent conflict resolution education, family and caregiver involvement in children’s activities, and structural changes within communities to address relevant socioeconomic factors that may contribute to violent behavior.

The investigators noted two limitations to this study. First, race and ethnicity were not separately categorized until 1990. Additionally, discrepancies between census-reported and death certificate–reported classifications of race and ethnicity may have resulted in underestimation of rates in certain groups, because of the misclassification of Hispanics, Asian/Pacific Islanders, and American Indian/Alaska natives.

Homicide has repeatedly ranked in the top three causes of death among the population aged 10-24 years. The authors of the CDC report stressed the importance of continued active involvement of the public health sector in ending the high rates of violence in these communities.

mrajaraman@frontlinemedcom.com

A new Centers for Disease Control and Prevention report has found a decline in homicide rates among U.S. residents aged 10-24 years, reaching a 30-year low of 7.5/100,000 in 2010.

Using data from the National Vital Statistics System, CDC analyzed youth homicide data from 1981 to 2010. Rates varied considerably over the 30-year period, with a sharp rise of 83% occurring from 1985 to 1993, but homicide rates in the youth population experienced a decline starting in 1994; that decline has slowed since 1999. Firearm homicides consistently outnumbered non–firearm homicides as the cause of death; the annual rate of firearm homicides was 3.7 times that of non–firearm homicides during the 30-year period (MMWR 2013,62:545-8).

"These findings highlight the fact that despite an overall decline in homicide to a 30-year low in 2010, some adolescents and young adults remain disproportionately affected," the study authors wrote. In 2010, homicide rates per 100,000 were 12.7 in males, 13.2 in the 20- to 24-year-old age group, and 28.8 for blacks.

The authors added that although there has been a decline in homicides among these high-risk populations, progress has slowed. A violence prevention approach starting in childhood is key to facilitating a continued reduction of youth homicide rates, they said. Such programs may include nonviolent conflict resolution education, family and caregiver involvement in children’s activities, and structural changes within communities to address relevant socioeconomic factors that may contribute to violent behavior.

The investigators noted two limitations to this study. First, race and ethnicity were not separately categorized until 1990. Additionally, discrepancies between census-reported and death certificate–reported classifications of race and ethnicity may have resulted in underestimation of rates in certain groups, because of the misclassification of Hispanics, Asian/Pacific Islanders, and American Indian/Alaska natives.

Homicide has repeatedly ranked in the top three causes of death among the population aged 10-24 years. The authors of the CDC report stressed the importance of continued active involvement of the public health sector in ending the high rates of violence in these communities.

mrajaraman@frontlinemedcom.com

A new Centers for Disease Control and Prevention report has found a decline in homicide rates among U.S. residents aged 10-24 years, reaching a 30-year low of 7.5/100,000 in 2010.

Using data from the National Vital Statistics System, CDC analyzed youth homicide data from 1981 to 2010. Rates varied considerably over the 30-year period, with a sharp rise of 83% occurring from 1985 to 1993, but homicide rates in the youth population experienced a decline starting in 1994; that decline has slowed since 1999. Firearm homicides consistently outnumbered non–firearm homicides as the cause of death; the annual rate of firearm homicides was 3.7 times that of non–firearm homicides during the 30-year period (MMWR 2013,62:545-8).

"These findings highlight the fact that despite an overall decline in homicide to a 30-year low in 2010, some adolescents and young adults remain disproportionately affected," the study authors wrote. In 2010, homicide rates per 100,000 were 12.7 in males, 13.2 in the 20- to 24-year-old age group, and 28.8 for blacks.

The authors added that although there has been a decline in homicides among these high-risk populations, progress has slowed. A violence prevention approach starting in childhood is key to facilitating a continued reduction of youth homicide rates, they said. Such programs may include nonviolent conflict resolution education, family and caregiver involvement in children’s activities, and structural changes within communities to address relevant socioeconomic factors that may contribute to violent behavior.

The investigators noted two limitations to this study. First, race and ethnicity were not separately categorized until 1990. Additionally, discrepancies between census-reported and death certificate–reported classifications of race and ethnicity may have resulted in underestimation of rates in certain groups, because of the misclassification of Hispanics, Asian/Pacific Islanders, and American Indian/Alaska natives.

Homicide has repeatedly ranked in the top three causes of death among the population aged 10-24 years. The authors of the CDC report stressed the importance of continued active involvement of the public health sector in ending the high rates of violence in these communities.

mrajaraman@frontlinemedcom.com

Depression is frequently overdiagnosed and overtreated in American adults, according to a national survey study.

The study explored whether patients identified as depressed by their clinicians also met the DSM-IV diagnostic criteria for 12-month major depressive episodes (MDE). Results showed that of the 5,639 participants with clinician-identified depression, only 38.4% actually met the MDE criteria. Additionally, a majority of participants reported using prescribed psychiatric medications, regardless of whether they met MDE conditions.

"This finding highlights the growing trends in prescription and use of psychiatric medications, and especially antidepressants, in the USA, even in the absence of a psychiatric diagnosis," wrote study author Dr. Ramin Mojtabai of the department of mental health at Johns Hopkins Bloomberg School of Public Health, Baltimore.

A sample of adult participants was drawn from the 2009 and 2010 National Survey of Drug Use and Health (NSDUH). Participants completed an assessment in the form of a computer-assisted in-person interview to determine whether they met DSM-IV criteria for major depressive episodes. Using questions derived from the Composite International Diagnostic Interview (CIDI) from the National Comorbidity Survey Replication, participants had to meet 5 of 9 symptom criteria and the DSM-IV clinical significance criteria (distress or impairment in functioning).

In addition to diagnostic criteria for depression, participants also were asked to report any inpatient or outpatient treatment or medications sought and prescribed over the past 12 months. Demographic information, such as education, general health, and employment status, also was collected.

Results showed that adults in the groups aged 35-49 years and 65 years and older were less likely to meet the 12-month MDE criteria than were adults aged 18-25 years.

"In contrast, participants who were out of the workforce, those who were divorced or separated, the more educated and those with poorer self-rated health were more likely to meet the 12-month MDE criteria," Dr. Mojtabai wrote.

He added that the rate of false-positive diagnosis found in this study echoes that of prior research, and that numerous factors could contribute to this high rate, such as a generally low incidence of depression in community settings, a lack of clinician knowledge about diagnostic criteria, and "ambiguity regarding subthreshold syndromes."

Dr. Mojtabai noted a few limitations to this study. First, he speculated that the true prevalence of clinician-diagnosed depression is likely much higher than is estimated in this study, as many doctors might not share their diagnostic impressions with patients. Second, he cautioned that structured interviews and clinician diagnoses are measures of "imperfect sensitivity." Third, the type of doctor was not specified in the NSDUH survey used to recruit participants. Fourth, some patients diagnosed with depression might in fact have another disorder, such as anxiety or adjustment disorder, which might benefit from antidepressant medication. And lastly, some adults with depression might require long-term treatment to prevent recurrence after remission.

He mentioned a more vigilant approach to diagnosing mental health disorders, originally suggested by Laura Batstra, Ph.D., and Dr. Allen Frances, "which allows clinicians to avoid labeling subthreshold symptoms and mild conditions with psychiatric diagnoses" and encourages the use of less intense psychological interventions when appropriate (Psychother. Psychosom. 2012;81:5-10).

Dr. Mojtabai explained that this study underscores the challenge of accurately diagnosing mental disorders, and as primary care starts to play a larger role in mental health care, special priority should be given to improved diagnosis and treatment of psychiatric conditions.

Dr. Mojtabai disclosed receiving consulting fees from Lundbeck Pharmaceuticals.

mrajaraman@frontlinemedcom.com

On Twitter @mrajaraman

Depression is frequently overdiagnosed and overtreated in American adults, according to a national survey study.

The study explored whether patients identified as depressed by their clinicians also met the DSM-IV diagnostic criteria for 12-month major depressive episodes (MDE). Results showed that of the 5,639 participants with clinician-identified depression, only 38.4% actually met the MDE criteria. Additionally, a majority of participants reported using prescribed psychiatric medications, regardless of whether they met MDE conditions.

"This finding highlights the growing trends in prescription and use of psychiatric medications, and especially antidepressants, in the USA, even in the absence of a psychiatric diagnosis," wrote study author Dr. Ramin Mojtabai of the department of mental health at Johns Hopkins Bloomberg School of Public Health, Baltimore.

A sample of adult participants was drawn from the 2009 and 2010 National Survey of Drug Use and Health (NSDUH). Participants completed an assessment in the form of a computer-assisted in-person interview to determine whether they met DSM-IV criteria for major depressive episodes. Using questions derived from the Composite International Diagnostic Interview (CIDI) from the National Comorbidity Survey Replication, participants had to meet 5 of 9 symptom criteria and the DSM-IV clinical significance criteria (distress or impairment in functioning).

In addition to diagnostic criteria for depression, participants also were asked to report any inpatient or outpatient treatment or medications sought and prescribed over the past 12 months. Demographic information, such as education, general health, and employment status, also was collected.

Results showed that adults in the groups aged 35-49 years and 65 years and older were less likely to meet the 12-month MDE criteria than were adults aged 18-25 years.

"In contrast, participants who were out of the workforce, those who were divorced or separated, the more educated and those with poorer self-rated health were more likely to meet the 12-month MDE criteria," Dr. Mojtabai wrote.

He added that the rate of false-positive diagnosis found in this study echoes that of prior research, and that numerous factors could contribute to this high rate, such as a generally low incidence of depression in community settings, a lack of clinician knowledge about diagnostic criteria, and "ambiguity regarding subthreshold syndromes."

Dr. Mojtabai noted a few limitations to this study. First, he speculated that the true prevalence of clinician-diagnosed depression is likely much higher than is estimated in this study, as many doctors might not share their diagnostic impressions with patients. Second, he cautioned that structured interviews and clinician diagnoses are measures of "imperfect sensitivity." Third, the type of doctor was not specified in the NSDUH survey used to recruit participants. Fourth, some patients diagnosed with depression might in fact have another disorder, such as anxiety or adjustment disorder, which might benefit from antidepressant medication. And lastly, some adults with depression might require long-term treatment to prevent recurrence after remission.

He mentioned a more vigilant approach to diagnosing mental health disorders, originally suggested by Laura Batstra, Ph.D., and Dr. Allen Frances, "which allows clinicians to avoid labeling subthreshold symptoms and mild conditions with psychiatric diagnoses" and encourages the use of less intense psychological interventions when appropriate (Psychother. Psychosom. 2012;81:5-10).

Dr. Mojtabai explained that this study underscores the challenge of accurately diagnosing mental disorders, and as primary care starts to play a larger role in mental health care, special priority should be given to improved diagnosis and treatment of psychiatric conditions.

Dr. Mojtabai disclosed receiving consulting fees from Lundbeck Pharmaceuticals.

mrajaraman@frontlinemedcom.com

On Twitter @mrajaraman

Depression is frequently overdiagnosed and overtreated in American adults, according to a national survey study.

The study explored whether patients identified as depressed by their clinicians also met the DSM-IV diagnostic criteria for 12-month major depressive episodes (MDE). Results showed that of the 5,639 participants with clinician-identified depression, only 38.4% actually met the MDE criteria. Additionally, a majority of participants reported using prescribed psychiatric medications, regardless of whether they met MDE conditions.

"This finding highlights the growing trends in prescription and use of psychiatric medications, and especially antidepressants, in the USA, even in the absence of a psychiatric diagnosis," wrote study author Dr. Ramin Mojtabai of the department of mental health at Johns Hopkins Bloomberg School of Public Health, Baltimore.

A sample of adult participants was drawn from the 2009 and 2010 National Survey of Drug Use and Health (NSDUH). Participants completed an assessment in the form of a computer-assisted in-person interview to determine whether they met DSM-IV criteria for major depressive episodes. Using questions derived from the Composite International Diagnostic Interview (CIDI) from the National Comorbidity Survey Replication, participants had to meet 5 of 9 symptom criteria and the DSM-IV clinical significance criteria (distress or impairment in functioning).

In addition to diagnostic criteria for depression, participants also were asked to report any inpatient or outpatient treatment or medications sought and prescribed over the past 12 months. Demographic information, such as education, general health, and employment status, also was collected.

Results showed that adults in the groups aged 35-49 years and 65 years and older were less likely to meet the 12-month MDE criteria than were adults aged 18-25 years.

"In contrast, participants who were out of the workforce, those who were divorced or separated, the more educated and those with poorer self-rated health were more likely to meet the 12-month MDE criteria," Dr. Mojtabai wrote.

He added that the rate of false-positive diagnosis found in this study echoes that of prior research, and that numerous factors could contribute to this high rate, such as a generally low incidence of depression in community settings, a lack of clinician knowledge about diagnostic criteria, and "ambiguity regarding subthreshold syndromes."

Dr. Mojtabai noted a few limitations to this study. First, he speculated that the true prevalence of clinician-diagnosed depression is likely much higher than is estimated in this study, as many doctors might not share their diagnostic impressions with patients. Second, he cautioned that structured interviews and clinician diagnoses are measures of "imperfect sensitivity." Third, the type of doctor was not specified in the NSDUH survey used to recruit participants. Fourth, some patients diagnosed with depression might in fact have another disorder, such as anxiety or adjustment disorder, which might benefit from antidepressant medication. And lastly, some adults with depression might require long-term treatment to prevent recurrence after remission.

He mentioned a more vigilant approach to diagnosing mental health disorders, originally suggested by Laura Batstra, Ph.D., and Dr. Allen Frances, "which allows clinicians to avoid labeling subthreshold symptoms and mild conditions with psychiatric diagnoses" and encourages the use of less intense psychological interventions when appropriate (Psychother. Psychosom. 2012;81:5-10).

Dr. Mojtabai explained that this study underscores the challenge of accurately diagnosing mental disorders, and as primary care starts to play a larger role in mental health care, special priority should be given to improved diagnosis and treatment of psychiatric conditions.

Dr. Mojtabai disclosed receiving consulting fees from Lundbeck Pharmaceuticals.

mrajaraman@frontlinemedcom.com

On Twitter @mrajaraman

Parents’ social networks can play a substantial role in decision making about whether to vaccinate their children, according to an online survey study.

The study examined two types of social networks: "people" networks, comprising family members, friends, and health care providers; and "source" networks, which included books, magazines, news programs, and the Internet. Results showed that of all variables considered in the study, people networks were the most influential in parents’ decision making, particularly in parents who did not conform to recommended vaccination schedules.

"These results suggest that social networks, and particularly people networks, play a key role in shaping parents’ vaccination decisions," wrote study author Emily K. Brunson, M.P.H., Ph.D., of the department of anthropology at Texas State University, San Marcos (Pediatrics 2013;131:1-8 [doi:10.1542/peds.2012-2452]).

©Micah Young/istockphoto.com

Participants were first-time parents born in the United States with children aged 18 months or younger. All parents surveyed were residents of King County, Wash., a region known for below-average rates of vaccination. Dr. Brunson examined 196 eligible parents, of which 126 conformed to the nationally recommended vaccination schedule (conformers), and 70 who either delayed vaccination, vaccinated only partially, or did not vaccinate their children at all (nonconformers).

Parents completed an online survey consisting of three modules. The first asked participants about the people and sources they consulted for vaccination-related information and advice. Parents were asked to list their top five sources of vaccination information, as well as the advice provided by each person or source. The second module asked parents about their existing practices and attitudes toward vaccination, and the final survey module collected demographic information about the parents and their households.

Survey results showed "significant differences" in vaccination attitudes between conformers and nonconformers. Nonconformers were more likely to have negative perceptions of vaccination, and only 51% reported the intent to have their children fully vaccinated by the time they started kindergarten (vs. 100% of conformists). The findings also reported that 72% of people in the nonconformers’ social networks recommended nonconformity, as opposed to just 13% of people in the conformers’ networks.

Both groups ranked health care providers in their top five influential network members, although Dr. Brunson notes that in spite of health providers’ important role in their decision making, "the percent of network members recommending nonconformity was the most-important" predictor of parents’ vaccination decisions.

Dr. Brunson reported a few limitations to this study. The data were not collected as a random sample, meaning the results cannot be inferred as being representative of all parents in King County. Second, she noted that because of the study’s use of retrospective network data, "it is possible that recall bias may be an issue."

The author also reported that the sample size was not large enough to account for differences between types of nonconformity (such as delayed vaccination vs. no vaccination). Lastly, this report treats conformers and nonconformers as "cohesive groups". Although this is commonly done, Dr. Brunson wrote that this approach is "likely incorrect."

Because this study demonstrates the significant role of parents’ social networks in vaccination decision making, this area should continue to be studied, said Dr. Brunson. She also suggested that any future attempts to increase the acceptance of vaccinations should focus on the inclusion of these broad social networks, rather than just parents and health care providers.

This study was based on research supported by a grant from the National Science Foundation. Dr. Brunson reported no relevant financial disclosures.

mrajaraman@frontlinemedcom.com

Parents’ social networks can play a substantial role in decision making about whether to vaccinate their children, according to an online survey study.

The study examined two types of social networks: "people" networks, comprising family members, friends, and health care providers; and "source" networks, which included books, magazines, news programs, and the Internet. Results showed that of all variables considered in the study, people networks were the most influential in parents’ decision making, particularly in parents who did not conform to recommended vaccination schedules.

"These results suggest that social networks, and particularly people networks, play a key role in shaping parents’ vaccination decisions," wrote study author Emily K. Brunson, M.P.H., Ph.D., of the department of anthropology at Texas State University, San Marcos (Pediatrics 2013;131:1-8 [doi:10.1542/peds.2012-2452]).

©Micah Young/istockphoto.com

Participants were first-time parents born in the United States with children aged 18 months or younger. All parents surveyed were residents of King County, Wash., a region known for below-average rates of vaccination. Dr. Brunson examined 196 eligible parents, of which 126 conformed to the nationally recommended vaccination schedule (conformers), and 70 who either delayed vaccination, vaccinated only partially, or did not vaccinate their children at all (nonconformers).

Parents completed an online survey consisting of three modules. The first asked participants about the people and sources they consulted for vaccination-related information and advice. Parents were asked to list their top five sources of vaccination information, as well as the advice provided by each person or source. The second module asked parents about their existing practices and attitudes toward vaccination, and the final survey module collected demographic information about the parents and their households.

Survey results showed "significant differences" in vaccination attitudes between conformers and nonconformers. Nonconformers were more likely to have negative perceptions of vaccination, and only 51% reported the intent to have their children fully vaccinated by the time they started kindergarten (vs. 100% of conformists). The findings also reported that 72% of people in the nonconformers’ social networks recommended nonconformity, as opposed to just 13% of people in the conformers’ networks.

Both groups ranked health care providers in their top five influential network members, although Dr. Brunson notes that in spite of health providers’ important role in their decision making, "the percent of network members recommending nonconformity was the most-important" predictor of parents’ vaccination decisions.

Dr. Brunson reported a few limitations to this study. The data were not collected as a random sample, meaning the results cannot be inferred as being representative of all parents in King County. Second, she noted that because of the study’s use of retrospective network data, "it is possible that recall bias may be an issue."

The author also reported that the sample size was not large enough to account for differences between types of nonconformity (such as delayed vaccination vs. no vaccination). Lastly, this report treats conformers and nonconformers as "cohesive groups". Although this is commonly done, Dr. Brunson wrote that this approach is "likely incorrect."

Because this study demonstrates the significant role of parents’ social networks in vaccination decision making, this area should continue to be studied, said Dr. Brunson. She also suggested that any future attempts to increase the acceptance of vaccinations should focus on the inclusion of these broad social networks, rather than just parents and health care providers.

This study was based on research supported by a grant from the National Science Foundation. Dr. Brunson reported no relevant financial disclosures.

mrajaraman@frontlinemedcom.com

Parents’ social networks can play a substantial role in decision making about whether to vaccinate their children, according to an online survey study.

The study examined two types of social networks: "people" networks, comprising family members, friends, and health care providers; and "source" networks, which included books, magazines, news programs, and the Internet. Results showed that of all variables considered in the study, people networks were the most influential in parents’ decision making, particularly in parents who did not conform to recommended vaccination schedules.

"These results suggest that social networks, and particularly people networks, play a key role in shaping parents’ vaccination decisions," wrote study author Emily K. Brunson, M.P.H., Ph.D., of the department of anthropology at Texas State University, San Marcos (Pediatrics 2013;131:1-8 [doi:10.1542/peds.2012-2452]).

©Micah Young/istockphoto.com

Participants were first-time parents born in the United States with children aged 18 months or younger. All parents surveyed were residents of King County, Wash., a region known for below-average rates of vaccination. Dr. Brunson examined 196 eligible parents, of which 126 conformed to the nationally recommended vaccination schedule (conformers), and 70 who either delayed vaccination, vaccinated only partially, or did not vaccinate their children at all (nonconformers).

Parents completed an online survey consisting of three modules. The first asked participants about the people and sources they consulted for vaccination-related information and advice. Parents were asked to list their top five sources of vaccination information, as well as the advice provided by each person or source. The second module asked parents about their existing practices and attitudes toward vaccination, and the final survey module collected demographic information about the parents and their households.

Survey results showed "significant differences" in vaccination attitudes between conformers and nonconformers. Nonconformers were more likely to have negative perceptions of vaccination, and only 51% reported the intent to have their children fully vaccinated by the time they started kindergarten (vs. 100% of conformists). The findings also reported that 72% of people in the nonconformers’ social networks recommended nonconformity, as opposed to just 13% of people in the conformers’ networks.

Both groups ranked health care providers in their top five influential network members, although Dr. Brunson notes that in spite of health providers’ important role in their decision making, "the percent of network members recommending nonconformity was the most-important" predictor of parents’ vaccination decisions.

Dr. Brunson reported a few limitations to this study. The data were not collected as a random sample, meaning the results cannot be inferred as being representative of all parents in King County. Second, she noted that because of the study’s use of retrospective network data, "it is possible that recall bias may be an issue."

The author also reported that the sample size was not large enough to account for differences between types of nonconformity (such as delayed vaccination vs. no vaccination). Lastly, this report treats conformers and nonconformers as "cohesive groups". Although this is commonly done, Dr. Brunson wrote that this approach is "likely incorrect."

Because this study demonstrates the significant role of parents’ social networks in vaccination decision making, this area should continue to be studied, said Dr. Brunson. She also suggested that any future attempts to increase the acceptance of vaccinations should focus on the inclusion of these broad social networks, rather than just parents and health care providers.

This study was based on research supported by a grant from the National Science Foundation. Dr. Brunson reported no relevant financial disclosures.

mrajaraman@frontlinemedcom.com